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Advice On Approaching My Pcp For Referral?

Insurance

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3 replies to this topic

#1 kimberlynn

kimberlynn

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  • LocationLong Beach, CA
  • Age:30
  • Surgeon:not yet
  • Hospital:not yet
  • Height (ft-in):5-04
  • Start Weight:230
  • Current Weight:230
  • Goal Weight:130
  • Body Mass Index (BMI):40
  • Surgery Date:not yet
  • Surgery Type:Gastric Band

Posted 15 February 2012 - 04:37 PM

I'm getting a physical and approaching my PCP (this Tuesday) about referring me for gastric banding. I have Health Net HMO. I have a BMI of 41 however I do not have any comorbidities. I have battled my weight since I can remember, I've tried everything except weight loss surgery. I am already discouraged. I do not want them to tell me No. I would be devastated. Any advice on approaching my doctor and dealing with hmo insurance?

#2 cocoa

cocoa

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  • Surgeon:Dr. Charles Callery
  • Hospital:Sharp Memorial, San Diego, CA
  • Surgery Date:02/15/2008
  • Surgery Type:Gastric Band

Posted 15 February 2012 - 05:13 PM

Have you contacted your insurance company yet to determine if they cover WLS? If they do, what are their requirements? Most that cover WLS do so with a BMI of 40 or over with no co-morbidities, but they all have individual requirements. Some require 6 month supervised diet programs. All require some medical testing.

Approaching a PCP can be tough. If he or she has a weight problem, too, it can make it easier. If you have a long history together, that can help also. Mainly speak calmly and rationally. Show that you've done your research and say that this is what you want. You KNOW that another diet will not work, you've been there, done that. Diets fail. WLS is proven effective.
Banded 2-15-2008 / Begin Pre-Op Diet 210
Dr. Charles Callery / Day of Surgery 202 / Current 146
San Diego, CA
All time high, 217



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#3 Jennifer B.

Jennifer B.

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  • LocationCalifornia
  • Age:32
  • Surgeon:Dr. Parvez
  • Hospital:Clovis Community Medical Center
  • Height (ft-in):5-03
  • Start Weight:350
  • Current Weight:244
  • Goal Weight:130
  • Body Mass Index (BMI):43.2
  • Surgery Date:08/10/2012
  • Surgery Type:Gastric Bypass

Posted 16 May 2012 - 08:05 PM

My best advice is do not accept no for an answer from your pcp. For 8 years I went back and forth with my Dr. He kept telling me do south beach diet, or atkins. He kept saying I didnt need surgery because I was young and cute and could lose the weight myself. I topped out at 350 pounds. I wish I had pushed harder, stuck to my guns on at least getting a referal and letting a surgeon decide if surgery was right for me. I could have saved myself years of misery and further weight gain.


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#4 nomad70

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  • LocationAlabama
  • Age:42
  • Surgeon:Dr. Lane
  • Hospital:Mobile Infirmary Medical Center
  • Height (ft-in):5-06
  • Start Weight:240
  • Current Weight:168
  • Goal Weight:150
  • Body Mass Index (BMI):28.4
  • Surgery Date:05/03/2012
  • Surgery Type:Gastric Bypass

Posted 17 May 2012 - 03:51 AM

I just matter of factly went in to my PCM and said, I want a referral for gastric bypass. My original PCM was a military Nurse Practitioner and she was great. She said absolutely, and was very excited for me. Then we moved and I had to somewhat start the process again, this time I had a male NP who was not in the military. I was nervous about that, but I had already had one from the other state. Again, he was great about it and suggested where I go. I took his advice and I am glad I did, the surgeon I have is great. I am two weeks post op and no complications, feeling great. Now, if I had hit any road blocks, I would have just switched providers. I know my mom has had a couple of doctors who didn't agree with this surgery. One even wrote a letter to her surgeon stating her reasons my mom should not have it. Her surgeon laughed and said I get those all the time from doctors who don't agree with the surgery. As long as her health and weight dictate a necessity, he did the surgery. she was self pay, so she didn't have to pass insurance requirements.
Heather :ph34r:


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